Existing Patient - Pain Specialists of Greater Chicago

If you are an existing patient needing help, we have a few options for you.

1. Use our patient portal.

2. OR – Call us at 630-371-9980

3. OR – If you are having any difficulty with the phone system, please email at PatientHelp@painchicago.com

4. OR – fill out the following form:

Please complete pain diagram and bring to your appointment. If there are any Demographic/Insurance changes or HIPAA updates, please complete and bring to your appointment. Thank you.

Forms:

Patient Demographics
Signature Sheet
HIPAA Form
ARI Form
Requisition for Forms – FMLA and Other
Request for Release of Medical Records
Authorization for Release of Medical Records
(Please complete a request for form and fax it to our office at 630-371-1555. There is a 10 business day turnaround time)
New Patient Packet
Request Medical Records
Benefits Assignment Policy
Interventional Procedure Instructions
Credit Card Authorization Form
Patient Agreement for Controlled Substances

Policies:

From the kick off, I was very impressed as for his level of concern he had for me. Many ways to approach my problem, detailed AT MY LEVEL OF UNDERSTANDING! Explanation at first visit To my procedure, followup calling me to see how things were going. He cares and keeps one in the loop.

Frank L

I want to share my great experience. I've been dealing with leg and back pain for at least 2 years. i was referred to Doctor Glaser, Maria and David. They are all pleasant, professional and they have your best interest in dealing with pain. They are so helpful and listen to you to determine the best way to put your pain under control. They take their time with you and don't rush the appointment. The staff that welcomes you is also very pleasant. I can't say "Thank You" enough to the doctor and his great staff....they are the best!

Patricia B